Although using the fingertip to palpate the trachea and endotracheal tube is a useful technique to locate the tip of the endotracheal tube during the procedure, it is unreliable, particularly in patients with short and thick necks. There are reports of lower rates of acute complications under endoscopic (bronchoscopic) guidance [7-11]. However, there is no adequate controlled study showing that endoscopic-guided tracheostomy is superior to the 'blind' one. Moreover, it is an expensive tool which is not readily available in some centers.